肝癌患者血清和腹水可溶性肿瘤坏死因子受体-p55的测定

Detection of soluble tumor necrosis factor-p55 levels in the serum and ascitic fluid of patients with hepatocellular carcinoma

目的 进一步了解肝癌患者的异常免疫状态,探讨血清、腹水中可溶性肿瘤坏死因子受体-p55（sTNFR-p55）检测的临床意义。方法 以双单抗夹心酶免疫吸附法检测了25例肝癌患者和25例肝硬化患者的血清、腹水中血清sTNFR-p55水平并以正常人为对照。结果肝癌病人血清sTNFR-p55浓度[（0.74±0.50）ng/ml]显著高于正常人[（0.37±0.03）ng/ml]和肝硬化患者和[（0.35±0.02）ng/ml],P<0.01。肝癌病人腹水sTNFR-p55浓度[（1.11±1.25）ng/ml]亦显著高于肝硬化患者[（0.33±0.03）ng/ml],P<0.01。肝癌、肝硬化患者血清与腹水的sTNFR-p55水平显著相关。肝癌患者血清sTNFR-p55水平与外周血TBil和AFP呈正相关（r=0.524,P=0.01和r=0.234,P=0.03）。结论 sTNFR-p55的检测对反映肝癌患者的异常免疫状态和肿瘤诊断具有实用价值。

Objective To examine soluble tumor necrosis factor receptor-p55 (sTNFR-p55) levels in the serum and ascitic fluid and investigate the significance of this examination in assessment of the clinical status of patients with primary hepatocellu-lar carcinoma (HCC). Methods Enzyme-linked immunosorbent assay (ELISA) was used to examine sTNFR-p55 levels in the serum and ascitic fluid in 25 patients with HCC and 25 with liver cirrhosis (LC). Results sTNFR-p55 levels in the serum and ascitic fluid in patients with HCC were significantly higher than those in patients with LC and controls (P=0.001). No significant difference was found between LC and the control in terms of serum sTNFR-p55 levels (P=0.19). Positive correlation was observed between sTNFR-p55 levels in the serum and in ascitic fluid of patients with HCC and LC (r=1.000, P<0.001). Logistic regression revealed that in patients with HCC, serum sTNFR-p55 levels were positively correlated with TBil and AFP in the peripheral blood (r=0.524, P=0.01 and r=0.234, P=0.03, respectively). Conclusions Increased sTNFRs-p55 levels in the serum and ascitic fluid reflect abnormal immune status of the patients with HCC and help predict the development of tumor.